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How to Challenge Medical Bills

Hospitals, outpatient facilities and doctors’ offices can and do make mistakes. Unfortunately, chances are good you will never know unless you take it upon yourself to check medical bills for errors. With the high price tag of medical care, checking medical bills for errors and challenging incorrect charges is not something you should, it is something you must do. Check over medical bills as soon as you receive them and if errors or overcharges exist, there are numerous ways to challenge that bill and win.

Audit Bill

Request an itemized copy of the hospital bill. Compare this bill with the summary bill you receive to look for any discrepancies. Call the billing office to find out the procedure you will need to follow to secure these records. For example, you may need to fill out a form or make the request in writing.Call the medical records department and request a copy of doctor orders and nursing notes and the UBO4, which is the detailed bill your insurance company receives. This will give you an itemized listing of procedures, treatments and drugs administered during your stay.

If the office tries to deny your request, inform them you are entitled to receive a copy of these records under the Patients’ Bill of Rights, item 8.Check bills for errors. Read your insurance policy carefully to determine what they do and do not allow in medical billing. For example, many plans do not allow hospitals to charge for the day of discharge. Check your bill against doctor notes to ensure no charges exist for services canceled by your doctor. Look at bulk-charge items such as room fees, kit and tray fees to ensure you did not receive a separate charge for these as well.Ask questions. If there is anything you do not understand, ask for an explanation. It may be helpful to call the provider office directly to have your questions answered.

Challenge Bill

Call the hospital or doctor billing office. Inform the billing agent of the discrepancy in a calm and clear matter. Record the date and time of the call, the agent’s name and the disposition of the call in as much detail as you can. This call will most likely not resolve the issue and you will need this information as you continue this challenge. If the agent agrees to audit the bill and asks you to call back, get a commitment as to day and time of the callback and record this information as well.Call the fraud department of your medical insurance company. This is a good idea even if you were able to reach a resolution with the medical office’s billing department. Make sure to add this call to your call log for documentation purposes.Contact your state, county, or city consumer protection agency to file a complaint.

Additionally, many local television stations have a consumer affairs department and may be of some assistance.Hire legal representation or a medical billing advocate. A medical billing advocate will act on your behalf when challenging medical bills. Use this service as a last resort as this can be an expensive option. If you do choose this option, negotiate payment on a contingency basis so you will have to pay only if the advocate is successful.

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